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Organization
UNIVERSITY OF MINNESOTA PHYSICIANS
Active
Organization
UNIVERSITY OF MINNESOTA PHYSICIANS
Active
Other names
Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MARY JOHNSON COO (CHIEF OPERATING OFFICER)
(612) 884-0802
Entity
Organization
Contact information
Practice address
606 24TH AVE S, SUITE 200, MINNEAPOLIS, MN 55454-1455
(812) 659-8689
(612) 659-8690
Mailing address
606 24TH AVE S, SUITE 200, MINNEAPOLIS, MN 55454-1455
(612) 659-8689
(612) 659-8690
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
701372800
—
MN
Enumeration date
12/04/2008
Last updated
06/05/2013
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